Skip to main content
SpringerLink
Log in

Role of navigated total knee arthroplasty for acute tibial fractures in the elderly

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

The role of total knee arthroplasty (TKA) in acute tibial fractures with existing comminution/bone loss, osteoporosis or preexistent arthritis has been described in the literature. Many of these procedures necessitate the use of stems to off-load the component and augments/wedges to avoid overresection and hence restore the joint line. Conventional methods may not be consistently accurate in restoring the desired alignment within 3° of the anatomical axis in this complex scenario. Computer-assisted TKA has been demonstrated to reproducibly and accurately restore the mechanical axis and joint line in primary TKA. Literature review has sparse data on use of navigation in acute TKA.

Methods

9 cases of acute tibial fractures (6 tibial plateau and 3 diaphyseal) were treated by navigated primary knee arthroplasty and followed up over 26-month duration.

Results

All fractures healed without notable complications. Mean range of movement was 114°. Mean Knee Society score was 84. Out of 9 cases 5 were graded as excellent, 3 good and 1 fair. All knees were corrected to within a mean of 1.7° of the calculated mechanical axis.

Conclusion

Total knee arthroplasty should be considered a treatment option for acute upper tibial fractures in the elderly with coexistent knee arthritis and poor bone stock. Computer-assisted navigation aids in restoration of mechanical axis and component positioning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Rosen AL, Strauss E (2004) Primary total knee arthroplasty for complex distal femur fractures in elderly patients. Clin Orthop Relat Res 425:101–105

    Article  PubMed  Google Scholar 

  2. Ali AM, El-Shafie M, Willett KM (2002) Failure of fixation of tibial plateau fractures. J Orthop Trauma 16–5:323–329

    Article  Google Scholar 

  3. Haidukewych G, Sems SA, Huebner D, Horwitz D, Levy B (2007) Results of polyaxial locked-plate fixation of periarticular fractures of the knee. J Bone Joint Surg Am 89(3):614–620

    Article  PubMed  Google Scholar 

  4. Haidukewych G, Sems SA, Huebner D, Horwitz D, Levy B (2008) Results of polyaxial locked-plate fixation of periarticular fractures of the knee. Surgical technique. J Bone Joint Surg Am 90(Suppl 2 Pt 1):117–134

    PubMed  Google Scholar 

  5. Schandelmaier P, Partenheimer A, Koenemann B, Grun OA, Krettek C (2001) Distal femoral fractures and LISS stabilization. Injury 32(Suppl 3):SC55–SC63

    PubMed  Google Scholar 

  6. Weiss NG, Parvizi J, Trousdale RT, Bryce RD, Lewallen DG (2003) Total knee arthroplasty in patients with a prior fracture of the tibial plateau. J Bone Joint Surg Am 85-A(2):218–221

    PubMed  Google Scholar 

  7. Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K (2007) Metaanalysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplast 22(8):1097–1106

    Article  Google Scholar 

  8. Merloz P, Tonetti J, Cinquin P, Lavallee S, Troccaz J, Pittet L (1998) Computer-assisted surgery: automated screw placement in the vertebral pedicle. Chirurgie 123(5):482–490

    Article  PubMed  CAS  Google Scholar 

  9. Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73:709

    PubMed  CAS  Google Scholar 

  10. Brand M, Daley R, Ewald F (1989) Tibial tray augmentation with modular metal wedges for tibial bone stock deficiency. Clin Orthop 248:71

    PubMed  Google Scholar 

  11. Vermeire J, ScheerLinck T (2010) Early primary total knee replacement for complex proximal tibia fractures in elderly and osteoarthritic patients. Acta Orthop Belg 76(6):785–793

    PubMed  Google Scholar 

  12. Larsen JE, Chao EY, Fitzgerald RH (1991) Bypassing femoral cortical defects with cemented intramedullary stems. J Orthop Res 9:414–421

    Article  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Author information

Authors and Affiliations

  1. Adult Reconstruction Unit, Department of Orthopaedics, Tan Tock Seng Hospital, Level 4, Annex Building, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore

    Sunil Gurpur Kini & S. S. Sathappan

Authors
  1. Sunil Gurpur Kini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. S. Sathappan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sunil Gurpur Kini.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kini, S.G., Sathappan, S.S. Role of navigated total knee arthroplasty for acute tibial fractures in the elderly. Arch Orthop Trauma Surg 133, 1149–1154 (2013). https://doi.org/10.1007/s00402-013-1792-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-013-1792-8

Keywords

Search

Navigation